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Treating or not treating

PsA can cause permanent joint damage quickly when it is not treated and controlled.
This damage can occur even when the pain is not severe. 

Once damage occurs, it is not reversible and can cause significant pain and disability.

Patient

Treatment of PsA

With the guidance of your doctor and other healthcare professionals, you can manage your PsA.

  • Heat and cold to reduce pain and stiffness
  • You can take action to protect your joints. Physiotherapy and/or occupational therapy can help.
  • Proper skin care
  • Medications can help reduce inflammation in your joints in order to relieve pain and help slow joint damage.
  • Surgery may be an option for severely damaged joints.

NON-PHARMACOLOGICAL TREATMENTS

Heat (warm shower or warm pack) can help:

  • Relieve pain
  • Relieve muscle spasms and tightness
  • Increase range of motion

Use a protective barrier, such as a towel, between the warm pack and the skin.

To avoid making symptoms worse, heat should not be applied to an already inflamed joint.

Cold (cold pack or crushed ice, ice cubes, or a bag of frozen vegetables) can help:

  • Decrease swelling
  • Decrease pain
  • Reduce blood flow to an inflamed joint

Use a protective barrier, such as a towel, between the cold pack and the skin. 

You can use your joints in a way that reduces the stress placed on them. 

By protecting your joints, you may:

  • Experience less PsA pain
  • Perform tasks more easily
  • Help prevent further damage

Examples of how you can protect your joints:

  • Pace yourself throughout the day – alternate heavy tasks with lighter tasks and take breaks.
  • Position your joints to minimize stress (e.g., when carrying heavy items, keep them at waist height).
  • Talk to your doctor or other healthcare professional about splints, braces, or shoe inserts to help support your joints.

Consider assistive devices such as a cane and jar openers.

Skin care

Properly caring for your skin will help you manage your psoriasis. 

If you have severe psoriasis, you should see a dermatologist. 

Pros and cons of sunlight

  • Moderate exposure to sunlight can usually benefit those with psoriasis by slowing cell growth.
  • However, too much sunlight can damage your skin, so it is important to take steps to avoid sunburn.
  • Some types of psoriasis may be worsened by UV sun exposure.

PHARMACOLOGICAL TREATMENTS

NSAIDs are a type of medication used to treat the pain and inflammation of arthritis.

NSAIDs:

  • Can be taken on an as-needed basis and do not need to be taken regularly.

Some patients may find it helpful to take their NSAID on a regular basis to control their symptoms.

NSAIDs are available over the counter and by prescription. Talk to your doctor about NSAID treatment.

SIDE EFFECTS ASSOCIATED WITH NSAIDs:
Risk of GI side effects and thrombotic events; people with heart disease, or a history of stroke, or serious chest pain should not take NSAIDs.

The cornerstone of therapy is DMARDs. 

DMARDs are a class of medications used to treat inflammatory types of arthritis including PsA. Methotrexate is a DMARD commonly used to treat PsA.

DMARDs:

  • DMARDs slow down the persistent inflammation (pain, swelling, and stiffness) in the joints and can help prevent damage to the joint.

SIDE EFFECTS ASSOCIATED WITH DMARDs:
Vary according to agent: rash, nausea, abdominal discomfort, leucopenia, retinal and liver toxicity have been reported.

Cortisone (a steroid naturally present in our bodies):

  • Is a hormone produced naturally by the body’s adrenal glands.
  • Regulates routine inflammation from minor injuries and major traumas, such as broken bones or surgery.

The adrenal gland cannot produce enough cortisone naturally to regulate PsA. 

Corticosteroids may be used to get inflammation under control. Steroids work quickly (usually within a few days) and some patients may even start to feel better within hours of taking the first dose.

SIDE EFFECTS ASSOCIATED WITH CORTICOSTEROIDS:
Osteoporosis, hypertension, weight gain, fluid retention, hyperglycemia, cataracts, skin fragility, and possibly premature atherosclerosis

Biologics are a type of medication used to treat inflammatory types of arthritis, such as PsA.

Biologics:

  • Different types of biologics vary in the way they work in the body.
  • Like DMARDs, biologics are used to suppress inflammation and can help prevent damage to the joint.
  • Can take some time to work. 
  • Can be combined with DMARDs.

SIDE EFFECTS ASSOCIATED WITH BIOLOGICS:
Infusion or injection site reactions, and increased risk of serious infections, tuberculosis, and lymphoma. 

Surgery

Surgery may be considered by your doctor if a joint becomes badly damaged and is no longer functioning.

Surgery may benefit some people with severe, advanced PsA who have not responded to conservative pain management for their damaged joints.

Surgery:

  • May lead to less pain and better movement and function. 
  • Is not a treatment for the inflammation of PsA.

SIDE EFFECTS ASSOCIATED WITH SURGERY:
Vary depending on the procedure.